title: Neonatal hypoxic-ischaemic encephalopathy: most deaths followed end-of-life decisions within three days of birth.
abstract: OBJECTIVE
  To investigate the circumstances surrounding end-of life decisions (EoL) of infants with hypoxic-ischaemic encephalopathy (HIE) and examine changes over a 10-year period.
  
  
  METHODS
  Retrospective chart review of all infants with HIE who died during 2000-2004 and 2005-2009 in a Level III Neonatal Intensive Care Unit in Madrid, Spain.
  
  
  RESULTS
  Of 70 infants with HIE, 18 died during the neonatal period. The mean age of death was 64.4 ± 51 h. In 17 of the 18 infants (94%), death was preceded by an EoL decision, four after withholding therapy (WH) and 13 after withdrawal therapy (WDT). All infants with WH were previously stable and without respiratory support, while all 13 infants in the WDT group had respiratory support and three were unstable. The age of death was greater in the WH group than the WDT group (122 ± 63 h vs 50 ± 34; p < 0.001). After the EoL decision, 11 (65%) infants received sedatives. There were no differences between the time periods.
  
  
  CONCLUSIONS
  In our cohort, most deaths in newborns with HIE were preceded by EoL decisions mainly within the first 3 days after birth. We did not find changes over the first decade of the 21st century, and death was mainly determined by WDT.
authors.affiliation: Agrupacio Sanitaria Hospital Sant Joan de Déu-Hospital Clinic-Maternitat, University of Barcelona, Barcelona, Spain; Hospital Universitario La Paz, Autonoma University of Madrid, Madrid, Spain. agarciaalix@hsjdbcn.org.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Garcia-Alix
authors.forename: Juan
authors.initials: J
authors.lastname: Arnaez
authors.forename: Veronica
authors.initials: V
authors.lastname: Cortes
authors.forename: Monserrat
authors.initials: M
authors.lastname: Girabent-Farres
authors.forename: Gemma
authors.initials: G
authors.lastname: Arca
authors.forename: Albert
authors.initials: A
authors.lastname: Balaguer
mesh_terms: D054810:Deep Sedation; D005260:Female; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000401:mortality*; D007231:Infant, Newborn; D008297:Male; D016414:Resuscitation Orders; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D028761:Withholding Treatment
keywords: End-of-life care; Hypoxic-ischaemic encephalopathy; Neonatal death; Withdrawal; Withholding